Cigarette smoking, STI/HIV risk behaviors, and psychosocial mediators among African American adolescent females

Background: Little is known about the association of cigarette smoking and psychosocial mediators of sexual risk behaviors, HIV/STI risk behaviors, and STI outcomes among African American female adolescents.

Methods: Cross-sectional baseline data were collected from 15 to 21 year old African American females (N=715) participating in an HIV intervention program in Atlanta, GA. Data collection included 1) a survey of demographic, psychosocial, and behavioral measures and 2) self-collected, laboratory-confirmed vaginal swabs for trichomoniasis, chlamydia, and gonorrhea. MANCOVA was used to assess differences between smokers (currently smoking one or more cigarettes per day) and non-smokers for five established psychosocial mediators: peer norms, sex refusal self-efficacy, condom use self-efficacy, partner sexual communication self-efficacy, and self-esteem. Logistic regression was used to assess the relationship between smoking with risk behaviors and incident STIs.

Results: Controlling for demographic factors and inter-correlations among mediating variables with MANCOVA, smokers had significantly higher scores for peer norms that support high risk behavior (p=.0001), lower sex refusal self-efficacy (p=.028), and lower self esteem (p=.0001). Compared to non-smokers, smokers were more likely to have sex with multiple partners in the past 60 days (OR = 1.67, 95% CI = 1.16-2.41, p = .006) and be diagnosed with an incident STI (OR = 1.59, 95% CI = 1.08-2.35, p = .018).

Conclusions: Cigarette smoking may serve as a marker for a high risk sexual health profile among African American adolescent females. Prevention efforts aiming to reduce STI/HIV risk among African American female adolescents may benefit from targeting smokers.